CURRENT STATUS AND CHALLENGES OF ENDOSCOPIC TREATMENT FOR ESD-DIFFICULT CASES OF SUPERFICIAL ESOPHAGEAL CANCER

Abstract

ESD is an established minimally invasive treatment for superficial esophageal cancers. However, ESD for circumferential lesions, those at or around post-treatment scars, lesions coexisting with esophageal varices, and recurrent lesions after chemoradiotherapy (CRT) remains challenging. Although circumferential lesions are favorable candidates for ESD, postoperative strictures remain controversial. Lesions occurring in areas of scarred ulcers and those that recur after CRT are candidates for intractable ESD, with a high possibility of non-curative resection and complications. Furthermore, lesions complicated by esophageal varices are at risk of bleeding. Alternative endoscopic treatments for ESD, such as photodynamic therapy, argon plasma coagulation, and radiofrequency ablation, have recently drawn much attention in cases intractable to ESD with promising clinical efficacy.